HAPE: high altitude pulmonary edema 高海拔肺水腫
剛好在臉書上看到網友分享 HAPE 案例, 照片裡面有高壓氧艙
所以上uptodate 查詢一下關於HAPE使用高壓氧治療的建議.
目前沒找到其他這樣治療的案例. 一般高海拔的醫療院所, 是以常壓氧氣治療
氧氣可舒緩因缺氧造成的肺動脈高壓, 也可保護腦部以及其他器官, 可以降低心跳速率及呼吸速率.
High-altitude pulmonary edema from uptodate(連結在此)
Literature review current through: Nov 2021.
This topic last updated: Jul 29, 2021.
Oxygen — Supplemental oxygen is first-line therapy for HAPE and should be provided in all treatment settings when available [34-37]. It can be lifesaving. Relieving hypoxemia is the most effective method of reducing pulmonary artery pressure, reversing capillary leak, and protecting the brain and other organs. Supplemental oxygen immediately increases partial pressure of oxygen (PaO2) and reduces both the heart and respiratory rates.
若氧氣供應不充足, 低流量長時間使用氧氣會比高流量短時間效果更好.
供氧及下降(或高壓艙治療)是理想的治療方式.
*攜帶式加壓艙是使用空氣加壓, 與高壓氧艙不同, 且攜帶式加壓艙的氣壓通常不會大於1大氣壓, 而是模擬海拔下降一千公尺左右的氣壓效果
*高壓氧艙的氣壓, 通常會加壓到 2.5~3 ATM, 世界各地有很多種不同的治療模式時間, 可使用美國海軍制定的標準做參考(美國海軍過去對高壓氧研究最多)
Based on the authors' field experience, when supplies are limited, low-flow oxygen given for a longer duration is preferable to high flow and short duration. Supplemental oxygen combined with descent (or hyperbaric therapy) is the ideal treatment.
北美位於滑雪勝地附近的醫院, 海拔約 2500-3000 公尺, 使用高流量鼻導管供氧(鼻導管給氧通常是每分鐘 1-6 公升), 若需要流量更高的氧氣, 每分鐘 6 公升以上, 應改用氧氣面罩, 給氧治療數小時, 根據患者氧氣飽和度調整給氧的量, 直到患者需求的氧氣濃度小於等於每分鐘 3 公升為止, 期間維持血氧飽和度 90% 以上, 當患者臨床症狀改善, 適合門診追蹤, 就可以回家(回旅館)繼續使用氧氣製造機, 並要求需休息, 每天評估患者狀態及血氧飽和度, 直到患者不使用氧氣仍可維持血氧飽和度在 90% 以上,
治療過程通常是 2-3 天, 接下來 1-3 天可慢慢恢復活動, 若狀況還好, 不一定需下降高度, 但下降當然還是隨時需考慮的治療手段.
In the hospital setting, supplemental oxygen and rest are generally sufficient therapy [34,37]. A common regimen in North American hospitals near ski resorts (elevation approximately 2500 to 3000 meters) is to treat with high-flow supplemental oxygen by nasal cannula or face mask for several hours until the patient's oxygen requirement is ≤3 L/min, with the oxygen saturation (SpO2) maintained at 90 percent or higher. If the patient is clinically improved and appropriate for outpatient therapy, they may be sent home with an oxygen concentrator to be used continuously and strict instructions to rest. The patient's condition and SpO2 are rechecked daily until an ambulatory SpO2, measured while the patient breathes room air, is ≥90 percent. The usual duration of oxygen therapy is two to three days. At this point, supplemental oxygen is discontinued. The patient is advised to return to activity gradually over the following one to three days. Descent is not mandatory but is always an option in this setting.
2002 NEJM 一氧化碳中毒使用不同高壓氧治療方式(之前筆記在此)
最初24小時, 給予三個療程的高壓氧, 高壓氧療程設定在實驗中又分成幾種不同模式
https://www.nejm.org/doi/full/10.1056/NEJMoa013121
先看下面的第一個和第二個圖案, 第一個艙室在15分鐘內, 將壓力提高到 3atm, 維持60分鐘, 接著在5分鐘內將壓力下降到 2atm, 維持30分鐘, 之後在10分鐘內將壓力下降到0.85atm.
其他高壓氧治療模組直接看圖, 就不另外用文字敘述了.
"肺水腫住院4天，痊癒出院了, 三天兩夜, 八通關登玉山北峰"
沒有留言:
張貼留言